Knowledge and Awareness on Rehabilitation of Missing Tooth in Partially and Complete Edentulous Population a Questionnaire Survey

1. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 11457 - 11462
Received 25 April 2021; Accepted 08 May 2021.
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Knowledge and Awareness on Rehabilitation of Missing Tooth in Partially
and Complete Edentulous Population a Questionnaire Survey
Dr. Bala Nikhitha Gopu1
, Dr. Vikram V Khare2
, Dr. Sonali Perti3
, Dr. Preeti Budhwar4
, Dr.
Deepali Dongle5
, Dr. Priyansh Gaind6
,Dr. Heena Tiwari7
1
BDS, Vokkalighara Sangha Dental College and Hospital, Bangalore. gnikhita94@gmail.com
2
Professor and Head, Department of Oral Medicine and Radiology, Dr.DY Patil Vidyapeeth
Pune. kharevikram@yahoo.co.in
3
Professor, Department of Prosthodontics, Kalinga Institute of Dental Sciences,Campus 15
Rd, KIIT-Deemed to be University,Patia, Bhubaneswar, Odisha India.
sonaliperti7@gmail.com
4
MDS, Consultant Prosthodontist and Implantologist, Clove Dental Corporate Hospitals,
Hyderabad, Telangana. dr.preeti1992@gmail.com
5
3rd
year post graduate student, Department of Prosthodontics, crown & bridge, People's
College of Dental Sciences and Research Centre, Bhopal.
6
BDS (Dr. Harvansh Singh Judge institute of dental sciences and hospital, Panjab University,
Chandigarh India). 43 esplanade, Sydney, NS Canada B1P 1A2. gaindpriyansh@gmail.com
7
BDS, PGDHHM, MPH Student, Parul Univeristy, Limda, Waghodia, Vadodara, Gujrat,
India.drheenatiwari@gmail.com
Corresponding Author:Dr. Bala Nikhitha Gopu, BDS, Vokkalighara Sangha Dental College
and Hospital, Bangalore. gnikhita94@gmail.com
ABSTRACT:
Background: Various types of edentulism that can exist in a patient and it refers to a state in
which a single toothor many teeth are absent. This is often known as partial edentulism or
semi-edentulism. It is necessary to evaluate the edentulousareas of patient and also to
determine the number of the missing teeth. It is of prime importance to identify the reason as
to know why most of the patients fail to replace their edentulous spaces in oral activity.
Objective: The aim of the study was to assessthe knowledge and awareness among the
population about the need for replacement of missing teeth in partially edentulous subjects.
Materials and Methods: A questionnaire-based survey comprising of 21 questions to assess
the knowledge of replacingmissing teeth in partially edentulous subjects was structured. The
survey was conducted among 200 subjects.
Results: 70 % of the subjects neglected prosthodontics treatment as they felt the treatment
was veryexpensive. Another main factor that the study revealed was that around 90% of these
subjects were unaware of the drawbacks of failureto replace the extracted teeth.
Conclusion: The present study has concluded that the level of awareness among the people
for theneed of tooth replacement had been significantly low. It was evident from the study
that it is required to emphasize on the replacementof teeth and also to bring in the innovative
methods to in order to demonstrate this need.
KEYWORDS: Awareness, Edentulism, Knowledge, Missing tooth, Partial Edentulism.
INTRODUCTION:
Various types of edentulism can exist in a patient. Edentulism refers to a state in which a
single tooth or teeth are absent. It is often referred as partial edentulism or semi-edentulism.1
It is necessary to evaluate the edentulous areas of patient and determine the number of
missing teeth.2
Several classifications were introduced to enhance this process. This makes the
communication between the professionals easier while discussing the cases. 3, 4
Main features

2. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 11457 - 11462
Received 25 April 2021; Accepted 08 May 2021.
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of the classification included evaluation of tooth borne or tooth-tissue borne removable
partial denture (RPD), immediate visualization of missing teeth and it serves as a guide in
order to design the prosthesis. The classifications establish a relationship between the
edentulous spaces and the remaining natural dentition of patient.5
The rehabilitation options
for long span partially edentulous patient with multiple missing teeth include RPD with
attachment, conventional cast partial denture, fixed partial denture (FPD) or implant retained
prosthesis. The responsibility of dental practitioner in order to diagnose and also recommend
the best replacement option for patient.6
Besides, implants as a fixed replacement option, it is
essential to provide the other fixed replacements post evaluation of the periodontium.7
It is
also essential that patient’s oral hygiene is to be assessed when such treatments are indicated.
8
Sometimes the cast partial dentures are avoided due to presence of metal being visible in
oral cavity. 9
The aim of the present study is to assess the knowledge and awareness among
the population regarding the need for the replacement of missing teeth when partially
edentulous.
MATERIALS AND METHODS:
The targeted group for this study was 200 subjects with more than one tooth missing. The
exclusion criteria are: a) extracted 18, 28, 38, and 48, b) subject had fixed or removable
prosthesis. The subjects between age range of 20 and 50 were included for this study. Both
male and female patients were included in the study. Each of these subjects was provided
with a questionnaire, structured in English for better perception of the questionnaire. The
questions were 21 in number. The survey comprised of questions on when their teeth/tooth
were removed, were they informed about the replacement options, knowledge on replacement
of teeth, any replacement treatment they tried but failed or any discomfort due to edentulous
spaces, oral hygiene level and so on. The responses were collected and the results of this
study were obtained.
RESULTS:
On the basis of this study, it is been proven that patients were unaware of the drawbacks of
not having replaced their teeth. It was surprising when the study revealed that
only 6% of the targeted population were aware of the various disadvantages of not replacing
teeth that were extracted. This reveals the poor awareness among subjects with edentulous
spaces regarding the need to replace them. Most of the subjects were females and about 38%
of them had not replaced their missing teeth. When the number of missing teeth was
evaluated, nearly 46% of the subjects were present with only a single missing tooth. Mostly,
the reasons stated for removal were deep caries, failed root canal treatment, periodontally
compromised, and accidents. While nearly 29% had at least five teeth missing, there was over
29% showing almost more than five missing teeth. The subjects were asked to state if they
had difficulty in mastication and/or if they felt that their esthetics were compromised, (Graph
1). As far as awareness of all modes of prosthodontic treatment were concerned (Graph 2),
most of the men and women were aware of the removable and fixed denture. Only around
one fourth of the subjects were aware of the implants as a mode of prosthodontic
rehabilitation. Moreover, most of the men and women seemed to prefer the fixed denture to
implants and even removable dentures. (Graph 3). Most women felt that loss of teeth led to
loss of esthetics while men felt that their masticatory capabilities had been compromised. A
majority of 58% of the patients had undergone extraction of teeth in the past 4 years.
Assessing the bone quality in the remaining subjects, it seemed compromised in those
individuals with an extraction time period of more than 12 years. Approximately 78% of
patients complained about the discomfort, particularly during the eating due to edentulism.
Aesthetic discomforts were complained by those who had missing anterior teeth. Nearly 23%

3. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 11457 - 11462
Received 25 April 2021; Accepted 08 May 2021.
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of these subjects had undertaken temporary replacement options. Unfortunately, most of the
treatments were a failure due to the patient’s disinterest and weak prosthesis’s weak retention.
Thus, 23% of subjects discontinued their treatment. The dentists who had performed these
extractions had provided the information to the subjects regarding the cost and varying
treatment options. However, only 19% of the clinicians had failed to provide the information
in regard to the need for replacement as well as the replacement of teeth options. 70 %
subjects neglected the treatment, as they felt the treatment was very expensive. Another key
finding of the study was that 94% of the subjects were unaware of the drawbacks of failure to
replace the extracted teeth There could be two reason for this, that is either the dentist would
have failed to mention the harmful causes or the subject would have been uninterested for
replacement due to financial issues. Irrespective of the findings of the survey, it is evident
that the people with partial edentulism have poor knowledge on the importance of replacing
their missing teeth. Thereby, newer methods must be incorporated by the dentists in order to
provide the patients with a better understanding for restoring the missing teeth.
Graph 1:Need to get replacement of missing teeth
Graph 2: Awareness to the different treatment modalities
0
20
40
60
80
100
Masticatory Difficulties Esthetic Shortcomming
Need to get replacement of missing teeth
Males Females
0
10
20
30
40
50
60
70
80
Removable Dentures Fixed Dentures Implants
Males Females

4. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 11457 - 11462
Received 25 April 2021; Accepted 08 May 2021.
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Graph 3: Preferences to various treatment modalities
DISCUSSION:
Numerus factors because of edentulism may be because of caries, periodontal disease,
infection, trauma, malignancies or failed endodontic treatments which may indirectly cause
harm to the existing dentition. This also hampers the well-being of the patient. Petridis et al.10
in his study reported that apart from the loss of teeth and supra eruption of the opposing teeth,
he also observed some positional changes in the tooth adjacent to the extracted site. It
indicated the migratory movement of the teeth. Moreover, Kini and Muliya 11
identified that
the supra eruptive movements can exist even when the coronal tissue of the opposing teeth is
broken down. Teeth loss can also case facial asymmetry. Study by Matins-Junior and
Marques 12
showed that the premature loss of a lower right deciduous canine in an 8-year-old
patient resulted in a deviation of lower arch from midline to the affected side just as in the
study by Tallgren et al.13
which observed that facial collapse in patients with teeth and the
alveolar bone loss. Lack of teeth has affected patients even systemically, causing them to
alter their dietary requirements. Thereby they eventually end up taking the fluids and lose out
on nutrition needed for human body.14
Many times in order to overcome the chewing
difficulty, people over-prepare their food, making it lose all its potentially nutrients.15
Some
studies have also demonstrated that even a single tooth loss can cause more damage too.It
was reported by Rosenstial et al. 16
that failure to replace a posterior missing tooth may
disrupt the balance in the stomatognathic relation and can also trigger the chains of adverse
reaction such as rotation, drifting or super eruption of teeth. Ineffective mastication, altered
speech, loss of self-confidence, feeling of bereavement and concern about appearance are
quite when people to tend to neglect the need to replace their missing teeth. In some cases,
even completely edentulous patients tend to avoid the treatment, which affects their food
intake resulting is improper food intake and low nutritional status. Beside the functional,
social, and the psychology toil on the patients, they still seem to neglect the treatment. This
could be due to poor awareness that failure to replace the missing teeth can also further
deteriorate the remaining dentition. 17
Prosthetic replacement of the missing teeth is an
important element of dental care. Patients with a single missing tooth can be treated with
RPDs. The prosthetic replacement of the missing teeth is an important element of the dental
care. Oral health is always an inseparable part of general health and awareness plays a key
0
10
20
30
40
50
60
Implants Fixed dentures Removable dentures
Males Females

5. Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 6, 2021, Pages. 11457 - 11462
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role in determining the oral health of individual. Poor oral health and loss of teeth, especially
complete loss or edentulism, are equivalent to dental death.18
Thereby, tooth loss causes the
residual ridge resorption leading to a decreased masticatory function affecting the dietary
intake, nutritional status, and also feeling of old age, hence compromising the general health.
The knowledge and attitude of the patient toward the replacement of teeth should be assessed
in order to educate the patient accordingly and also to improve the patient compliance with
the acceptance of prosthesis.19
The estimation of the treatment requirement is also an
important component in the oral health-care planning. It is possible to assess future treatment
needs and demands for services with this information. Moreover, the need for dental
prosthesis varies from patient to patient and depends on their age, sex, occupation,
socioeconomic background, and literacy. Rehabilitative treatment is successful only when the
patients are motivated and also made aware of the various prosthodontic treatments available,
its use and maintenance.
CONCLUSION:
When the dentists impart knowledge to the patients about the replacement needs for missing
teeth with more pictorial methods and graphics, it will register faster and better in the
patient’s mind. Moreover, the finances for treatment can also be modified by introducing
payments by instalments, price drops, etc., which may serve beneficial to the patients having
low socioeconomic status. Along with the replacement treatments, patients must also be
educated about the maintenance proper oral hygiene habits for the longevity of the dental
treatment done to restore the missing teeth. Hence, dental practitioner can impart the
knowledge effectively to make the difference.
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